Journal Article

Predictors of aggressive behaviour after acquired brain injury in a large UK sample cohort

Silva Ramos Sara D, Matarin, Mar, Jung, Theresa

2025

Overview

Background and ObjectivesAggression after acquired brain injury (ABI) is common and has implications for rehabilitation and community reintegration. It is also a major burden to patients and caregivers (Alderman et al. 2013). The aim of this study was to identify clinical and demographic factors associated with aggression post-ABI.MethodThe first prospective cohort study included 484 individuals who exhibit aggression (AG) (verbal, physical, or both) and 732 who had injuries of similar severity but did not display aggressive behaviour (NAG) and used scores on the Mayo-Portland Adaptability Inventory-IV (MPAI-4), the BIRT Independent Living Scales (BILS), and the Supervision Rating Scale (SRS), alongside other demographic and clinical factors (e.g. age on admission, gender, months since injury, type of injury, alcohol and substance use before the injury). In the second study a 6-months admission severity score derived from the Overt Aggression Scale – Modified for Neurorehabilitation was created to compare 184 AG to 154 NAG on several demographic characteristics and cognitive domains to identify predictors of aggression in a series of logistic regression analyses.ResultsIn the first study, aggression was associated with longer time since injury, TBI, male sex, younger age, more functional disability and poorer adjustment. Aggression was also associated with more pre-injury psychiatric disturbance (alcohol and drug use, depression and psychotic symptoms). In the second study, compared to NAG, AG patients exhibited significantly worse performance on working memory, immediate and delayed visual memory, recognition, visuo-constructional skills, flexibility, abstraction, letter fluency and processing speed compared to NAG. No significant differences were found in premorbid IQ, verbal IQ and other cognitive measures including attention, verbal memory, and other executive skills. The aggression severity score within the first 6-months of admission was significantly negatively correlated with cognitive measures of visual memory recognition, visuospatial and visuo-constructional skills. All FDR corrected p-values<0.05.ConclusionsThe presence of aggression was associated with specific cognitive impairments, demographic characteristics or psychiatric symptoms. Aggression was also more likely to affect social functioning and independence and was associated with longer time since injury. This highlights the importance of early intervention and long- term monitoring for aggression post-ABI.ReferenceAlderman N, Wood RL. Neurobehavioural approaches to the rehabilitation of challenging behaviour. NeuroRehabilitation 2013;32(4):761–70.

• Publisher: BMJ Publishing Group LTD
• Subject: Aggressiveness / Memory / Traumatic brain injury